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Topic: BILLING FEES (Read 3773 times)

I am an outpatient biller and charge per claim. I have just begun billing inpatient professional services for a doctor and I would like to know the best way to charge. Could I still charge per claim or service? Is it per patient? Or per length of stay?

That's up to you and your contract, I always think it best to do a complete analysis before quoting the provider any fees. There are pro's and con's to each method. In some states it's illegal for providers to enter into percentage based (fee-splitting) contracts. I personally like the monthly fee so that I can get paid for my time either way.

The contract states "per claim" however the dispute between biller and physician is the definition of "claim". I look at it as "per day". Each day a service was provided in the hospital is a seperate charge. She thinks one claim is the entire length of stay in the hospital. If they are in the hospital for 10 days, then that is one claim charge not 10 claims.

Again, this is for inpatient professional service billing for Mental Health.

The contract states "per claim" however the dispute between biller and physician is the definition of "claim". I look at it as "per day". Each day a service was provided in the hospital is a separate charge. She thinks one claim is the entire length of stay in the hospital. If they are in the hospital for 10 days, then that is one claim charge not 10 claims.

Well the contract SHOULD be more specific in defining what a "claim" is, there is going to be a problem if it's not defined.Personally if I were going to bill on a per claim basis my contracts might define "per claim" differently depending on the type of provider. For example, for some types I might define per claim as PER date of service and another it might be further defined by submission (per date, per dayslips submitted) for example you might have a small provider (therapist for example) that sees patients once a week and submits their billing to you once a month or once every two weeks.

For your scenerio, I'm not clear on the exact services but I wouldn't want to be billed PER date for an inpatient stay, it really should be per hospital stay, per claim FORM. JMO

With flat fee pricing the medical billing company charges a fixed dollar rate for each claim submitted regardless of the size of the claim.

Similar to percentage based agreements flat fee per claim pricing can vary significantly depending on the volume of claims and the extent of services provided. In its most basic form a fee per claim medical billing service might provide only claim generation and submission services for as little as a dollar or two per claim. In this case it would be the practice’s responsibility to follow up on claims. Of course flat fee per claim pricing can also include other services such as follow up with carriers patient invoicing etc. With these additional services practices might expect costs to increase to $4 $5 or even $7 per claim or more.

Actually another way is a flat monthly fee. So if a provider sees 100 patients a month and the average claim is $500 (based on an inpatient claim for multiple visits) and you anticipate it taking you approximately 30 hours a month then you may want your flat monthly fee to be $3000 per month with a limit on the number of claims/patients. If they exceed the limit the fee goes up. There are other factors to consider as well, I'm just trying to present an idea of what goes into calculating monthly fees. The specialty will make a difference. You need to consider how involved the claims may be in terms of follow up/appeals, etc.

what do you guys consider per claim, is it one date of service or is it base on how many CMS form submitted. For example, if I charge $4 per claim does that mean I charge for one date of service on a CMS form. I know you can have up to 6 dates of service in one CMS, does that consider as one claim. I'm a little confused with the flat fee pricing. I like the percentage better but I live in Florida and I know the percentage is not allowed

I was wondering if charging a small company a flat fee of $400.00/mo. as a starting point was a decent amount. This would only be for my first client which I know has a limited clientele. My thought was to use OfficeAlly as well but am not sure about the cost incurred with them..any feedback would be super..Thanks..Mona

there's not enough information to say if $400 is a good flat fee, depending on so many variables it could actually be a high figure for some practices. You shouldn't just PICK a fee..That fee should be based on ALL variables including your time, expenses, etc..